Post-Transplant Lymphoproliferative Disorder after Autologous Hematopoietic Cell Transplantation for Hodgkin's Lymphoma

Abstract

Post-transplant lymphoproliferative disorder is a very rare complication post autologous bone marrow transplant with few cases reported so far. We report a case of a child with history of classic Hodgkin's lymphoma, nodular sclerosis type, who was treated with autologous stem cell transplantation. Three months after the transplant, he developed bilateral cervical lymphadenopathy, splenomegaly, neutropenia and thrombocytopenia. Excisional biopsy of a left cervical lymph node revealed a post-transplant lymphoproliferative disorder. The morphological pattern of this post-transplant lymphoproliferative disorder was combined monomorphic and polymorphic, with plasmacytoid/plasmablastic differentiation expressing CD20 and CD79A. Kappa and lambda light chain immunohistochemistry stains showed a clear evidence of lambda light chain restriction. Immunohistochemistry stain and in situ hybridization for Latent membrane protein-1 were positive for Epstein-Barr virus. Polymerase chain reaction study revealed monoclonal B-cell proliferation with immunoglobulin heavy chain gene rearrangement. The patient was treated with prednisolone as 2 mg/kg/day over 2 weeks with tapering over the following 3 months. The white cell count recovered with regression of splenomegaly and cervical lymphadenopathy. On his last visit to the outpatient clinic, two years after the diagnosis of post-transplant lymphoproliferative disorder, he was in good health with normal laboratory parameters.